* No later than 9am when TSH is highest (TSH needs to be as high as possible when looking for a diagnosis)
* Water only before the test to avoid any food or drink interfering with TSH level
* No biotin or other supplement containing biotin (eg B Complex) for 3-7 days before the test
If so then his TSH is rising and he could well be on his way to hypothyroidism. However, with a TSH still in range, a mid-range FT4 and fairly decent FT3 nothing points to a diagnosis at this stage. A normal healthy person with no thyroid problem would generally have a TSH no higher than 2, often around 1, with TSH around mid-range-ish.
Vit D is recommended to be 100-150nmol/L. As summer is coming his level may naturally rise if he goes out in the sun. Maybe retest end of October as he may need to supplement during the winter months.
B12 is good but folate is low and needs improving. Folate is recommended to be at least half way through range so around 35 plus with that range. Maybe consider supplementing with a good quality bioavailable B Complex. Popular here are
Thorne Basic B if available at an acceptable price
Good idea to keep the test results for future reference. If he goes into a hypothyroid symptomatic state then these test results will give you a good place to aim for.
If he ends up with a Hashimotos underactive thyroid then keeping the TPO & Tgab antibodies low will be a good idea so you can preserve as much thyroid gland tissue as possible. This will help with any conversion of levothyroxine.
They won't treat at the moment but keeping copies of blood tests is a good idea. If it shows a continuous rise in TSH and a declining ft4 & Ft3 they may be allowed to treat before the TSH goes over the highest threshold. Generally though they won't.
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